Skip to main content

Advertisement

Log in

Erectile dysfunction: Interrelationship with the metabolic syndrome

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Erectile dysfunction (ED) is more commonly seen in men with various components of the metabolic syndrome (a constellation of various cardiovascular and diabetes risk factors). ED can be considered as a risk marker of the metabolic syndrome and its associated conditions. The patient with ED should be thoroughly evaluated for coexisting vascular disease. Any cardiovascular risk factors should be modified or treated (ie, smoking, diabetes, hypertension, and hyperlipidemia). Endothelial dysfunction is a major unifying etiology for many of the aspects of the metabolic syndrome, especially diabetes and cardiovascular disease. It also plays a major role in ED. The multifactorial etiology of ED, especially in patients with the metabolic syndrome, increases the complexity of managing this problem so clinicians need to be aware of the underlying pathophysiology to ensure the best possible outcomes in management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence [no authors listed]. JAMA 1993, 270:83–90.

    Article  Google Scholar 

  2. Matfin G: New treatments for erectile dysfunction. Fertil Steril 2003, 80(suppl 4):40–45.

    Article  PubMed  Google Scholar 

  3. Bacon CG, Mittleman MA, Kawachi I, et al.: Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med 2003, 139:161–168. Data revealed a 30% reduction in risk of ED in men who were most physically active. Conversely, watching more than 20 h/wk of TV, smoking, and being overweight was associated with increased risk of ED.

    PubMed  Google Scholar 

  4. Guay AT, Spark RF, Bansal S, et al.: American Association of Clinical Endocrinologists (AACE) medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple’s problem-2003 update. Endocr Pract 2003, 9:77–95.

    PubMed  Google Scholar 

  5. Grundy SM, Brewer HB Jr, Cleeman JI, et al.: Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004, 109:433–438.

    Article  PubMed  Google Scholar 

  6. Guven S, Kuenzi J, Matfin G: Diabetes mellitus and the metabolic syndrome. In Pathophysiology. Edited by Porth CM. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:987–1015.

    Google Scholar 

  7. Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002, 287:356–359.

    Article  PubMed  Google Scholar 

  8. Lue TF: Erectile dysfunction. N Engl J Med 2000, 342:1802–1813.

    Article  PubMed  CAS  Google Scholar 

  9. Saigal CS: Obesity and erectile dysfunction: common problems, common solution? JAMA 2004, 291:3011–3012.

    Article  PubMed  CAS  Google Scholar 

  10. Romeo JH, Seftel AD, Madhun ZT, Aron DC: Sexual function in men with diabetes type 2: association with glycemic control. J Urol 2000, 163:788–791.

    Article  PubMed  CAS  Google Scholar 

  11. McCulloch DK, Campbell IW, Wu FC, et al.: The prevalence of diabetic impotence. Diabetologia 1980, 18:279–283.

    Article  PubMed  CAS  Google Scholar 

  12. Kaiser FE: Erectile dysfunction in the aging man. Med Clin North Am 1999, 83:1267–1278.

    Article  PubMed  CAS  Google Scholar 

  13. Feldman HA, Goldstein I, Hatzichristou DG, et al.: Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994, 151:54–61.

    PubMed  CAS  Google Scholar 

  14. Klein R, Klein BE, Lee KE, et al.: Prevalence of self-reported erectile dysfunction in people with long-term IDDM. Diabetes Care 1996, 19:135–141.

    Article  PubMed  CAS  Google Scholar 

  15. Derby CA, Mohr BA, Goldstein I, et al.: Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk? Urology 2000, 56:302–306.

    Article  PubMed  CAS  Google Scholar 

  16. Esposito K, Giugliano F, Di Palo C, et al.: Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004, 291:2978–2984. Addressing risk factors for ED can reverse existing ED. Almost one third of obese men in this study had reversed their ED after exercising more and losing weight.

    Article  PubMed  CAS  Google Scholar 

  17. Calles-Escandon J, Cipolla M: Diabetes and endothelial dysfunction: a clinical perspective. Endocr Rev 2001, 22:36–52.

    Article  PubMed  CAS  Google Scholar 

  18. Richardson D, Vinik A: Etiology and treatment of erectile failure in diabetes mellitus. Curr Diab Rep 2002, 2:501–509.

    PubMed  Google Scholar 

  19. Solomon H, Man JW, Jackson G: Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart 2003, 89:251–253.

    Article  PubMed  CAS  Google Scholar 

  20. Levine LA, Kloner RA: Importance of asking questions about erectile dysfunction. Am J Cardiol 2000, 86:1210–1213.

    Article  PubMed  CAS  Google Scholar 

  21. De Angelis L, Marfella MA, Siniscalchi M, et al.: Erectile and endothelial dysfunction in type II diabetes: a possible link. Diabetologia 2001, 44:1155–1160.

    Article  PubMed  Google Scholar 

  22. Theuma P, Fonseca VA: Novel cardiovascular risk factors and macrovascular and microvascular complications of diabetes. Curr Drug Targets 2003, 4:477–486.

    Article  PubMed  CAS  Google Scholar 

  23. Billups KL, Kaiser DR, Kelly AS, et al.: Relation of C-reactive protein and other cardiovascular risk factors to penile vascular disease in men with erectile dysfunction. Int J Impot Res 2003, 15:231–236.

    Article  PubMed  CAS  Google Scholar 

  24. Chan NN, Chan JC: Asymmetric dimethylarginine (ADMA): a potential link between endothelial dysfunction and cardiovascular diseases in insulin resistance syndrome? Diabetologia 2002, 45:1609–1616.

    Article  PubMed  CAS  Google Scholar 

  25. Nash DT: Insulin resistance, ADMA levels, and cardiovascular disease. JAMA 2002, 287:1451–1452.

    Article  PubMed  Google Scholar 

  26. Stuhlinger MC, Abbasi F, Chu JW, et al.: Relationship between insulin resistance and an endogenous nitric oxide synthase inhibitor. JAMA 2002, 287:1420–1426.

    Article  PubMed  Google Scholar 

  27. Lin KY, Ito A, Asagami T, et al.: Impaired nitric oxide synthase pathway in diabetes mellitus: role of asymmetric dimethylarginine and dimethylarginine dimethylaminohydrolase. Circulation 2002, 106:987–992.

    Article  PubMed  CAS  Google Scholar 

  28. Mass R, Schwedhelm E, Albsmeier J, Boger RH: The pathophysiology of erectile dysfunction related to endothelial dysfunction and mediators of vascular function. Vasc Med 2002, 7:213–225.

    Article  Google Scholar 

  29. Masuda H, Tsujii T, Okuno T, et al.: Accumulated endogenous NOS inhibitors, decreased NOS activity, and impaired cavernosal relaxation with ischemia. Am J Physiol Regul Integr Comp Physiol 2002, 282:R1730-R1738.

    PubMed  CAS  Google Scholar 

  30. Cartledge JJ, Eardley I, Morrison JF: Impairment of corpus cavernosal smooth muscle relaxation by glycosylated human haemoglobin. BJU Int 2000, 85:735–741.

    Article  PubMed  CAS  Google Scholar 

  31. Sasaki T, Yasuda H, Maeda K, Kikkawa R: Hyperalgesia and decreased neuronal nitric oxide synthase in diabetic rats. Neuroreport 1998, 9:243–247.

    PubMed  CAS  Google Scholar 

  32. Veves A, Akbari CM, Primavera J, et al.: Endothelial dysfunction and the expression of endothelial nitric oxide synthetase in diabetic neuropathy, vascular disease, and foot ulceration. Diabetes 1998, 47:457–463.

    Article  PubMed  CAS  Google Scholar 

  33. Wei M, Macera CA, Davis DR, et al.: Total cholesterol and high density lipoprotein cholesterol as important predictors of erectile dysfunction. Am J Epidemiol 1994, 140:930–937.

    PubMed  CAS  Google Scholar 

  34. Saltzman EA, Guay AT, Jacobson J: Improvement in erectile function in men with organic erectile dysfunction by correction of elevated cholesterol levels: a clinical observation. J Urol 2004, 172:255–258.

    Article  PubMed  Google Scholar 

  35. Colberg SR, Stansberry KB, McNitt PM, Vinik AI: Chronic exercise is associated with enhanced cutaneous blood flow in type 2 diabetes. J Diabetes Complications 2002, 16:139–145.

    Article  PubMed  Google Scholar 

  36. Jiaan DB, Seftel AD, Fogarty J, et al.: Age-related increase in an advanced glycation end product in penile tissue. World J Urol 1995, 13:369–375.

    Article  PubMed  CAS  Google Scholar 

  37. Plante GE: Vascular response to stress in health and disease. Metabolism 2002, 51:25–30.

    Article  PubMed  CAS  Google Scholar 

  38. Seftel AD, Vaziri ND, Ni Z, et al.: Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or e NOS. Urology 1997, 50:1016–1026.

    Article  PubMed  CAS  Google Scholar 

  39. Xie Y, Garban H, Ng C, et al.: Effect of long-term passive smoking on erectile function and penile nitric oxide synthase in the rat. J Urol 1997, 157:1121–1126.

    Article  PubMed  CAS  Google Scholar 

  40. Fink HA, Mac DR, Rutks IR, et al.: Sildenafil for male erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med 2002, 162:1349–1360.

    Article  PubMed  CAS  Google Scholar 

  41. Guay AT, Perez JB, Velasquez E, et al.: Clinical experience with intraurethral alprostadil (MUSE) in the treatment of men with erectile dysfunction. A retrospective study. Medicated urethral system for erection. Eur Urol 2000, 38:671–676.

    Article  PubMed  CAS  Google Scholar 

  42. Carson CC, Burnett AL, Levine LA, Nehra A: The efficacy of sildenafil citrate (Viagra) in clinical populations: an update. Urology 2002, 60:12–27.

    Article  PubMed  Google Scholar 

  43. Brock GB, McMahon CG, Chen KK, et al.: Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol 2002, 168:1332–1336.

    Article  PubMed  CAS  Google Scholar 

  44. Porst H, Rosen R, Padma-Nathan H, et al.: The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial. Int J Impot Res 2001, 13:192–199.

    Article  PubMed  CAS  Google Scholar 

  45. DeSouza C, Parulkar A, Lumpkin D, et al.: Acute and prolonged effects of sildenafil on brachial artery flow-mediated dilatation in type 2 diabetes. Diabetes Care 2002, 25:1336–1339.

    Article  PubMed  CAS  Google Scholar 

  46. Katz SD, Balidemaj K, Homma S, et al.: Acute type 5 phosphodiesterase inhibition with sildenafil enhances flowmediated vasodilation in patients with chronic heart failure. J Am Coll Cardiol 2000, 36:845–851.

    Article  PubMed  CAS  Google Scholar 

  47. Halcox JP, Nour KR, Zalos G, et al.: The effect of sildenafil on human vascular function, platelet activation, and myocardial ischemia. J Am Coll Cardiol 2002, 40:1232–1240.

    Article  PubMed  CAS  Google Scholar 

  48. Gazzaruso C, Giordanetti S, De Amici E, et al.: Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation 2004, 110:22–26. Erectile dysfunction can be a marker of underlying vascular disease. The presence of ED was a predictor of silent CAD in patients with apparently uncomplicated type 2 diabetes.

    Article  PubMed  Google Scholar 

  49. Greenstein A, Chen J, Miller H, et al.: Does severity of ischemic coronary disease correlate with erectile function? Int J Impot Res 1997, 9:123–126.

    Article  PubMed  CAS  Google Scholar 

  50. Russell ST, Khandheria BK, Nehra A: Erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2004, 79:782–794. A survey of the current understanding of the interrelationship between ED and CVD.

    Article  PubMed  Google Scholar 

  51. Jackson G: Treatment of erectile dysfunction in patients with cardiovascular disease: guide to drug selection. Drugs 2004, 64:1533–1545.

    Article  PubMed  CAS  Google Scholar 

  52. Cheitlin MD, Hutter AM Jr, Brindis RG, et al.: Use of sildenafil (Viagra) in patients with cardiovascular disease. Technology and Practice Executive Committee. Circulation 1999, 99:168–177.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matfin, G., Jawa, A. & Fonseca, V.A. Erectile dysfunction: Interrelationship with the metabolic syndrome. Curr Diab Rep 5, 64–69 (2005). https://doi.org/10.1007/s11892-005-0070-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-005-0070-8

Keywords

Navigation